An important rationale for the changes in DSM-5 is the effort to capture “diagnostic orphans,” i.e., individuals meeting one or two criteria for dependence and none for abuse, and thus not receiving a DSM-IV SUD diagnosis (www.dsm5.org). Population studies show that changes in diagnostic prevalence resulting from the application of DSM-5 criteria are largely attributable to the assignment of a diagnosis to diagnostic orphans (Agrawal et al., 2011; Mewton et al., 2011). Hagman and Cohn (2011) found that 34.1% of 396 college students who reported any alcohol consumption in the past 90 days were DSM-IV diagnostic orphans. These individuals met an average of 1.4 alcohol dependence criteria. In contrast, using DSM-5 criteria, only 15% of individuals were diagnostic orphans, suggesting that, in college populations, DSM-5 provides greater diagnostic coverage for less severely affected individuals than DSM-IV. Combining this with evidence that diagnostic orphans are at increased risk to develop an AUD suggests that diagnostic orphans among college students and other groups could benefit from diagnosis and intervention (Harford et al., 2009). To assign diagnoses to these individuals, DSM-5 combines abuse and dependence criteria and reduces the number of criteria required for a diagnosis.
